吸烟对男性高血压患者晨间血压上升速度的影响  

The effect of smoking on the rate of morning blood pressure increase in male hypertensive patients

作　　者：许耀[1] 郝云霞[2] 崔爱东[1] 梁友玲[1] 赵燕[1] 于春英[1] 胡人月[1] 刘爱玲[1] 

机构地区：[1]山东省烟台市莱阳中心医院心血管内科,265200 [2]山东省烟台市莱阳中心医院肿瘤科,265200

出　　处：《中华高血压杂志》2012年第2期141-145,共5页Chinese Journal of Hypertension

摘　　要：目的探讨长期吸烟对男性高血压患者血压昼夜节律的影响,进一步阐述晨间血压上升速度是否是发生心血管事件的危险因素。方法选择男性高血压患者300例,年龄40～79岁,受试者均无糖尿病病史,根据吸烟状况分为不吸烟组(n=100)、戒烟组(n=100)和吸烟组(n=100),由同一研究小组完成24h动态血压监测,采用双重逻辑方程模型(double logistic curve-fitting procedure)分析动态血压参数并进行统计学分析。结果①各组间年龄、体质量指数、饮酒比例、高血压病程、血糖、血脂、血肌酐、血尿酸等差异无统计学意义(P>0.05)。②吸烟组24h平均收缩压、白昼平均收缩压、24h脉压比不吸烟组和戒烟组高(P<0.05或P<0.01),收缩压白昼平台较戒烟组高(P<0.05)。不吸烟组与戒烟组各项参数比较,差异无统计学意义(均P>0.05)。③吸烟组晨间收缩压上升速度要高于不吸烟组和戒烟组[(16.5±1.2)比(7.3±0.9)mm Hg/h,P<0.01;(16.5±1.2)比(9.8±0.9)mm Hg/h,P<0.01]。④单因素相关分析示晨间收缩压上升速度与收缩压白昼平台、24h脉压有相关性(r=0.151,0.143,P<0.05),不吸烟组及吸烟组收缩压上升速度仅与收缩压白昼平台有相关性(r=0.152,P<0.01;r=0.128,P<0.01)。校正年龄、体质量指数等因素后,偏相关分析显示:收缩压上升速度仍与收缩压白昼平台呈正相关(r总=0.232,P<0.01;r不吸烟=0.274,P<0.01;r吸烟=0.283,P<0.01)。⑤Logistic回归分析结果显示,晨间收缩压上升速度(OR=1.326,95%CI1.083～1.624,P=0.006)及收缩压白昼平台水平(OR=1.292,95%CI1.046～1.595,P=0.017)是靶器官损害的危险因素。结论长期吸烟的男性高血压患者白昼收缩压水平较高,晨间收缩压上升速度明显加快,晨间收缩压上升速度加快可能是心脑血管事件的危险因素。Objective The aims of this study were to investigate the effect of smoking on circadian rhythm of ambulatory blood pressure（ABP） in male hypertension patients and to evaluate relation between the rate of systolic blood pressure（SBP） increase in the morning and target organ damage.Methods Based on smoking status,300 male hypertension patients were divided into non-smoking（n=100）,smoking quitted（n=100） and smoking group（n=100）.Twenty-four hours ambulatory blood pressure monitoring and body mass index（BMI）,fasting blood glucose,serum total cholesterol,triglycerides,high density lipoprotein cholesterol（HDL-C） and low density lipoprotein cholesterol（LDL-C） were measured.A double logistic curve-fitting procedure was used to analyze ABP recordings and to determine the association between the rate of morning SBP increase and the incidence of myocardial infarction and stroke.Results ①The age,BMI,drinking habit,duration of hypertension,fasting blood glucose,serum total cholesterol,triglycerides,HDL-C,LDL-C and other parameters showed no significant differences（P0.05） among 3 groups.②The levels of 24 h mean systolic blood pressure（24hSBP）,daytime mean systolic blood pressure（dSBP） and 24 h pulse pressure（24hPP） in smoking group were significantly higher than non-smoking and smoking quitted groups（P0.05）.Non-smoking group and smoking quitted group showed no differences in all the parameters（P0.05）.③The rate of morning SBP increase in smoking group was significantly higher than non-smoking and smoking quitted groups ／[（16.5±1.2） vs（7.3±0.9） vs（9.8±0.9）mm Hg/h,P0.01／].④There was an association between the daytime SBP plateau（r=0.151,P0.05）,24hPP（r=0.143,P0.05） and rate of morning SBP increase.After adjusted for age,BMI,24hSBP and other parameters,the rate of morning SBP increase was significantly correlated with daytime SBP plateau（rtotal=0.232,rnon-smoking=0.274,rsmoking=0.283,all P0.01）.⑤Logistic regression analysis showed that t

关 键 词：吸烟 昼夜节律 动态血压 高血压 靶器官损害 

分 类 号：R544.1[医药卫生—心血管疾病]